title: The nutritional strategy: four questions predict morbidity, mortality and health care costs.
abstract: BACKGROUND
  Nutritional care for hospital in-patients is potentially important but challenging.
  
  
  OBJECTIVE
  To investigate the association between nutritional status and clinical outcomes.
  
  
  METHODS
  Eight prevalence surveys were performed at Haukeland University Hospital, Norway, during 2008-2009. In total 3279 patients were classified as being at nutritional risk or not according to the Nutritional Risk Screening (NRS 2002) tool. The initial four questions of NRS 2002 assess dietary intake, weight loss, body mass index (BMI) and illness severity.
  
  
  RESULTS
  The overall prevalence of nutritional risk was 29%. Adjusted mean days for hospitalisation was 8.3 days for patients at nutritional risk and 5.0 days for patients not at risk (p < 0.001). In adjusted models, patients at nutritional risk had increased one-year mortality (OR 4.07, 95% CI 2.90-5.70), morbidity (OR 1.59, 95% CI 1.18-2.13), and were 1.24 (95% CI 1.16-1.32) times more likely to have had a new admission during the three previous years and the one subsequent year, compared to patients not at risk. A 'positive' response to the initial four questions was associated with increased risk of morbidity and mortality. Patients with a reduced dietary intake during the last weeks had OR 1.72 (95% CI 1.03-2.85) for one-year mortality. Patients with a positive answer on all the initial four questions had ten times increased risk for mortality the following year, OR 13.0 (95% CI 4.52-37.6).
  
  
  CONCLUSIONS
  The four initial questions of the NRS 2002 robustly identify nutritional risk and were strong predictors of hospitalisation, morbidity and most importantly mortality among hospitalised patients. Thus, these simpler and short questions are robust indicators for subsequent poor outcomes.
authors.affiliation: Department of Research and Development, Haukeland University Hospital, Bergen, Norway; Kavli Research Centre for Ageing and Dementia, Haraldsplass Deacon Hospital, Bergen, Norway. Electronic address: randi.tangvik@helse-bergen.no.
authors.forename: Randi J
authors.initials: RJ
authors.lastname: Tangvik
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
authors.affiliation: Garvan Institute for Medical Research, St Vincent's Hospital, UNSW & University of Notre Dame, Sydney, Australia.
authors.forename: John A
authors.initials: JA
authors.lastname: Eisman
authors.affiliation: Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine 1, University of Bergen, Bergen, Norway.
authors.forename: Anne Berit
authors.initials: AB
authors.lastname: Guttormsen
authors.affiliation: Kavli Research Centre for Ageing and Dementia, Haraldsplass Deacon Hospital, Bergen, Norway.
authors.forename: Andreas
authors.initials: A
authors.lastname: Henriksen
authors.affiliation: Department of Research and Development, Haukeland University Hospital, Bergen, Norway.
authors.forename: Roy Miodini
authors.initials: RM
authors.lastname: Nilsen
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Jannike
authors.initials: J
authors.lastname: Øyen
authors.affiliation: Kavli Research Centre for Ageing and Dementia, Haraldsplass Deacon Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Anette Hylen
authors.initials: AH
authors.lastname: Ranhoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002149:Energy Intake; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D044342:Malnutrition / Q000191:economics* / Q000453:epidemiology*; D008875:Middle Aged; D009017:Morbidity; D009664:Norway; D015596:Nutrition Assessment; D009749:Nutrition Surveys / Q000191:economics; D009752:Nutritional Status; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult
keywords: Clinical outcome; Clinical predictor; Implement; Nutritional guidelines; Nutritional risk